Sonography of palpable breast cancer

PURPOSE: Because of the increasing use of sonography to rule out cancer in women with palpable breast abnormalities, this study was performed to determine the rate of sonographically occult malignancy in this clinical setting. METHODS: Women who were recommended for biopsy based on mammographic and/or clinical findings underwent breast sonography. This study retrospectively analyzed the subset of patients with palpable malignant lesions. Lesions were classified as visible or occult on mammography and sonography. Patients without a tissue diagnosis of tumor were excluded. RESULTS: Of 1,346 masses that underwent biopsy or aspiration, 616 lesions were palpable, and of these, 293 were malignant. Sonography detected all 293 palpable malignant lesions (95% confidence interval for sensitivity, 99-100%). Eighteen lesions were mammographically occult. The median lesion size as determined by sonography was 1.8 cm; for the lesions that were mammographically occult, the median size was 1.6 cm. The most common histopathologic diagnosis for both groups of lesions was infiltrating ductal carcinoma. CONCLUSIONS: All palpable malignant breast lesions were visible by sonography in patients in whom a biopsy was recommended. However, we caution that until the false-negative rate of sonography for equivocal palpable abnormalities is determined prospectively, sonography cannot be accurately applied to rule out malignancy in this setting.     

Sonographic appearance of normal intramammary lymph nodes

Sonographic breast examinations were performed on 1030 patients with palpable or mammographically detected masses. In five cases, the lesions were normal intramammary lymph nodes. The ultrasonographic characteristics of this entity were confirmed by a sonographic/pathologic correlation study carried out on a cadaver axilla. Normal lymph nodes appeared as well-defined echo-poor masses with echogenic centers. In the absence of other suspicious lesions or proven malignant tumors, these nodes should be considered benign and not biopsied, but followed by repeat examinations.     

Metastases to intramammary lymph nodes in patients with breast cancer: sonographic findings

PURPOSE: To describe the sonographic characteristics of intramammary lymph node metastasis (ILNM) in patients with breast cancer and to assess the value of sonography and sonographically guided fine needle aspiration biopsy (FNAB) in their diagnosis. METHODS: We retrospectively reviewed the charts and films of 19 women with biopsy-documented ILNM who were seen in our breast diagnostic center between December 1999 and July 2003. The sonographic appearance of the nodes was analyzed and correlated with clinical and mammographic findings and with biopsy results. RESULTS: The ILNMs were clinically and mammographically occult in 7 (37%) of the 19 women. The diameter of the ILNMs was less than 1 cm in 15 (79%) cases. The volume of the central echogenic hilum was less than 50% of the total volume of the node in each of the patients. There was marked decrease in cortical echogenicity of the ILN in all cases. Metastatic involvement was established via sonographically guided FNAB in each of the 19 suspicious intramammary lymph nodes. CONCLUSION: Sonography and sonographically guided FNAB are valuable methods of assessment for ILNM in patients with known or suspected breast cancer. The most consistent sonographic features associated with ILNM were reduction in the volume of the central echogenic hilum and marked hypoechogenicity of the node's cortex.     

超声引导经皮穿刺导丝定位切除乳腺隐匿性病灶的价值

目的 探讨经超声引导下钩针定位对手术切除乳腺隐匿性病灶的价值.方法 对触诊阴性但超声检查阳性的乳腺和腋窝隐匿性病灶进行靶向钩针穿刺固定,外科手术切除活检,分析病灶良恶性、完全切除率及超声对其诊断的敏感性和特异性,评价该方法对手术时间、术后美容效果的影响.结果 61个隐匿性病灶中,恶性病灶16个(26.2%),良性病灶45个(73.8%);所有病灶均完整切除;超声对隐匿性乳腺癌的诊断敏感性93.8%,特异性91.1%.结论 超声靶向钩针固定技术可以协助手术准确定位隐匿性病灶,在保证病灶完全清除的前提下缩小手术切除范围,从而早期诊断和治疗乳腺癌.     

In vitro B-mode ultrasonographic criteria for diagnosing axillary lymph node metastasis of breast cancer.

Axillary lymph node status is an important factor for staging and treatment planning in breast cancer. Our study was performed in vitro on a node-by-node basis to evaluate the ability of B-mode ultrasonographic images to distinguish metastatic from nonmetastatic nodes. Immediately prior to histologic examination, individual dissected axillary nodes were scanned in a water bath using a 10 MHz B-mode ultrasonographic transducer. Four B-mode features (size, circularity, border demarcation, and internal echo) were evaluated for their ability to distinguish metastatic from nonmetastatic lymph nodes. Lymph node metastasis was indicated by (1) a large size (i.e., a length of the longest axis of 10 mm or greater); (2) a circular shape (i.e., the ratio of the shortest axis to the longest axis between 0.5 and 1.0); (3) a sharply demarcated border compared with surrounding fatty tissue; and (4) a hypoechoic internal echo, with obliteration of the fatty hilum. The sensitivity and specificity were compared for all combinations of features. We examined 84 histologically characterized axillary nodes from 27 breast cancer patients, including 64 nonmetastatic and 20 metastatic nodes. Of the criteria cited, circular shape was the best single feature for distinguishing metastatic from nonmetastatic nodes (sensitivity, 65%; specificity, 73%). The best combination of sensitivity (85%) and specificity (73%) was obtained using the criterion that a lymph node contained cancer when at least three positive features were present. The present in vitro study demonstrated that the sensitivity and specificity of B-mode ultrasonography for diagnosing lymph node metastasis were lower than 90%. Therefore, B-mode ultrasonography may not be an optimal noninvasive screening method for diagnosing axillary lymph node metastasis in breast cancer patients, particularly under in vivo clinical conditions.     

高频超声显示乳腺微小钙化灶

目的评价高频超声对乳腺微小钙化灶的诊断价值。方法对经钼靶X线片证实的56例患者的66个乳腺微小钙化灶进行高频超声观察,评价高频超声显示乳腺微小钙化灶的能力及影响因素,并对钙化的良、恶性倾向进行判断。结果66个乳腺微小钙化灶中,高频超声共显示出45个(68.18%),其中对恶性病变的微小钙化灶显示率(84.78%)大于良性病变(30.00%,P<0.05)。在声像图中,高频超声对低回声背景内的微小钙化灶的显示率(97.67%)大于正常回声背景内的微小钙化灶的显示率(13.04%,P<0.05)。结论高频超声可以显示乳腺微小钙化灶,对乳腺恶性病变和声像图中低回声背景内的微小钙化灶显示较好。当超声发现多发微小钙化时,多提示为恶性病变。     

超声引导穿刺活检对乳腺癌内乳淋巴结定性的诊断价值

目的:探讨超声引导经皮穿刺活检对乳腺癌内乳淋巴结定性的诊断价值。方法:对20例乳腺癌患者的肿大内乳淋巴结,在超声引导下行经皮穿刺活检。结果:穿刺活检成功率85.0%(17/20)。16例获得明确病理诊断,均发现癌细胞,诊断准确率94.1%(16/17),无严重并发症发生。结论:超声引导经皮穿刺乳腺癌肿大内乳淋巴结组织学活检是一种简便、安全、有效、诊断准确性较高的方法,能为临床诊断和治疗提供依据。     

超声在小乳腺癌中的诊断价值

目的探讨高频二维超声、彩色及能量多普勒血流成像（CDFI、PDI）对小乳腺癌的诊断价值。方法对86例小乳腺肿块（〈2．0cm）的二维超声声像图特征,CDFI、PDI等项指标进行对照分析。结果小乳腺癌与良性肿块在边界、后方回声情况、纵横比、有无钙化灶等四个方面均有统计学差异（P均〈0．05）。41例小乳腺癌中38例（92．7％）具有血流特征,其中穿入性血流23例（56．1％）,25例伴有同侧腋窝淋巴结转移;45例良性病变中9例伴有同侧腋窝淋巴结反应性肿大。结论小乳腺癌的二维图像、CDFI、PDI在诊断小乳腺癌及转移性腋窝淋巴结方面均有特征性表现,其特征性表现对提高小乳腺癌的早期诊断准确率,具有较高的临床应用价值。     

乳腺癌分期诊断中SPECT—CT同机图像融合技术的探讨

目的将SPECT-CT同机图像融合技术，应用于^99mTc—MIBI乳腺癌亲肿瘤显像，探讨对乳腺癌术前TNM分期的临床价值。方法对10例怀疑已发生淋巴或血行转移的乳腺癌患者，完成^99mTc—MIBI乳腺癌亲肿瘤显像及SPECT-CT同机图像融合处理，并进行图像评价。以术后与活检的病理结果作为参照标准。结果19例乳腺癌中，1例浸润性导管癌检查呈假阴性；18例阳性病例中，发生腋窝淋巴结转移10例，腋窝淋巴结伴锁骨上淋巴结转移3例，胸骨旁淋巴结转移2例，漏检2例，未发生淋巴结转移1例；本组中有2例肿瘤侵犯乳腺后间隙，有3例发生胸壁转移。经SPECT--CT同机图像融合处理后，完成了对所有阳性病例淋巴结的分组，并对肿瘤侵犯深部胸肌及胸壁转移，提供定位诊断信息。结论SPECT--CT同机图像融合技术，应用于^99mTc—MIBI乳腺癌亲肿瘤显像，对乳腺癌的术前TNM分期具有一定的临床应用价值。     

乳腺癌腋窝淋巴结转移超声表现与病理对照

目的：探讨腋窝淋巴结转移的超声表现。方法：采用二维及彩色多普勒超声对45例乳腺癌患者在术前对腋窝肿大淋巴结的形态、大小、内部回声及血流动力学指标进行观察。结果：病理证实的39例转移淋巴结形态更接近圆形，多呈融合状态。血流信号多位于周边，并随淋巴结的增大血流信号增多，多发性肿大淋巴结较单发性血流丰富。结论：转移性淋巴结在二维超声和彩色多普勒上各有其特征性表现，二者结合可提高检出乳腺癌淋巴结转移的准确性。     

老年女性乳腺癌的临床特征及超声诊断价值

目的探讨老年女性乳腺癌的临床特征及超声诊断价值。 方法回顾性选取2015年6月至2019年12月就诊于北京协和医院乳腺外科行乳腺病灶手术获得明确病理诊断的≥70岁的老年女性288例，共计298个病灶，获取完整的临床、病理及超声影像资料。分析纳入对象的临床表现、病理特征，应用诊断试验四格表计算超声对老年女性乳腺良、恶性病灶及不同就诊原因患者良、恶性病灶的诊断效能，以及对腋窝淋巴结转移的诊断效能。 结果288例患者中，自行触及肿块189例（65.63%）、乳头溢液23例（7.99%）、体检（临床查体、影像学检查）发现肿块76例（26.39%）。298个病灶中，恶性病灶272个（91.28%），良性病灶26个（8.72%）。263例乳腺癌患者中，160例（60.84%）行乳腺肿块局部扩大切除术，71例（27.00%）行乳腺癌改良根治术，31例（11.79%）行乳腺肿块局部扩大切除术及前哨淋巴结活检或腋窝淋巴结清扫术，1例（0.38%）行全乳切除术。其中237例初诊患者术后病理T分期为T1 127例（53.59%），T2 79例（33.33%）。超声对老年女性乳腺癌的诊断敏感度、特异度和准确性分别为95.59%、50.00%和91.61%，其中超声对以肿块为主诉（包括自行触及和体检筛查发现）患者乳腺癌的诊断准确性（94.53%）高于主诉为乳头溢液患者的诊断准确性（58.33%）。102例乳腺癌患者接受了腋窝淋巴结处理，其中45例病理证实为腋窝淋巴结转移。术前超声对于腋窝转移性淋巴结诊断的敏感度、特异度和准确性分别为93.33%、73.68%、82.35%。 结论老年乳腺癌患者大多数因临床症状就诊，肿瘤分期晚。超声对以肿块为主诉的老年乳腺癌患者的诊断准确性较高，但对乳头溢液患者的诊断准确性仍有待提高。超声术前评估对老年乳腺癌患者腋窝淋巴结临床治疗方式的选择有重要价值。     

彩超在乳腺癌诊断中的价值

目的　探讨乳腺癌的彩超诊断价值 ,分析误诊原因。方法　彩色多普勒对 5 2例乳腺癌患者癌肿的形态、大小、内部回声及血流动力学指标及临床资料 ,并检查有无腋窝淋巴结转移。结果　 5 2例乳腺癌中超声作出定性诊断 4 5例 ,占 86 5 4 % ;性质待定 2例 ,占 3 85 % ;误诊为良性病变 5例 ,占 9 6 2 %。结论　具有典型声像图的乳腺癌彩超诊断正确率较高 ,但对于瘤体较小而又不具有典型声像图的早期乳腺癌 ,彩超诊断比较困难 ,需结合临床表现、穿刺细胞学、乳房钼靶片等检查 ,以期达到尽早确诊 ,减少漏误诊     

高频彩色多普勒超声诊断乳腺癌腋窝淋巴结转移的价值

目的探讨高频彩色多普勒超声在乳腺癌腋窝淋巴结转移诊断中的应用价值。方法对266例乳腺癌患者的腋窝淋巴结行术前超声检查,对超声检出的152例腋窝淋巴结与术后病理结果对照,将其分为淋巴结转移组（93例）与淋巴结无转移组（59例）,并对超声所显示的两组淋巴结的最大径、纵横比、皮髓比及血流分布类型行对比分析,并运用受试者工作特性（ROC）曲线进行评价。结果淋巴结转移组93例与淋巴结无转移组59例患者的淋巴结最大径分别为（18．9±6．7）mm及（19．6±7．2）mm,差异无统计学意义（P〉0．05）;而淋巴结转移组淋巴结的纵横比及皮髓比的中位数值分别为1．5（1～2．6）与2．0（0．8～4）,与淋巴结无转移组的1．9（1～4．5）与0．5（0．2～2）比较差异均有统计学意义（均P〈0．05）;淋巴结转移组淋巴结血流分布以周围型及混合型居多,分别为54．5％（18／33）与30．3％（10／33）;淋巴结无转移组淋巴结血流分布则以中央型居多,占63．2％（12／19）。ROC曲线分析显示：取淋巴结纵横比≤1．8对诊断淋巴结转移的敏感度及特异度分别高达62．4％与62．7％;取淋巴结皮髓比≥1．0对诊断淋巴结转移的敏感度及特异度分别高达75．3％与86．4％。结论高频彩色多普勒超声观察乳腺癌腋窝淋巴结形态,并取淋巴结的纵横比≤1．8和（或）皮髓比≥1．0进行分析,可提高乳腺癌腋窝淋巴结转移的诊断率,值得深入探讨。     

乳腺癌超声征象与淋巴结转移关系的单因素及多因素分析

目的 探讨乳腺癌原发肿块、腋窝淋巴结超声征象与淋巴结转移的关系.方法 回顾性分析146例乳腺癌患者151个原发肿块(66个伴淋巴结转移,85个未转移)及腋窝淋巴结声像图特征,与病理结果对照,用单因素(X~2检验)和多因素(Logistic回归)分析各声像图特征与淋巴结转移的关系,对超声征象和病理的吻合度进行k系数检验.对乳腺癌中提示淋巴结转移的超声征象与有转移的腋窝淋巴结征象进行相关分析.结果 单因素和多因素分析显示肿块最大直径、血流分级及淋巴结最大皮质厚度与淋巴结转移关系密切(X~2=37.939、13.153、69.128,OR=6.632、3.714、35.442,P均<0.01),且与病理结果有较好的吻合度(k=0.501、0.690、0.673),能较准确地判断腋窝淋巴结转移.肿块最大直径、血流分级与淋巴结最大皮质厚度有较好相关性(X2=40.132、33.128,P均<0.01).肿块距体表距离以及间质纤维结构改变等征象对判断乳腺癌淋巴结转移有一定提示作用.结论 采用单因素及多因素分析乳腺癌超声征象能为术前准确判断腋窝淋巴结转移提供重要的依据.     

隐匿性乳腺癌外科治疗

目的 探讨隐匿性乳腺癌的外科治疗方法.方法 对11例隐匿性乳腺癌患者的临床资料进行回顾性分析.结果11例均为女性,年龄44～70岁,中位年龄55岁.首发症状均为腋窝肿物,左侧4例,右侧7例.合并锁骨上淋巴结转移2例.行改良根治术4例,保留乳房仅行腋窝淋巴清扫术3例,腋窝肿物切除术2例,锁骨上淋巴结活检2例.术后按乳腺癌治疗规范行放、化疗和内分泌治疗.随访8个月至9年6个月,死亡3例,5年生存率54.5%(6/11).结论 隐匿性乳腺癌应根据乳腺癌治疗规范进行综合治疗.手术可行改良根治术或根治性保乳术,对于乳腺无原发癌证据者可保留乳房仅行腋窝淋巴清扫术.     

Ultrasonographic differentiation of benign from malignant neck lymphadenopathy in thyroid cancer.

OBJECTIVE: The aim of this study was to determine whether ultrasonography itself was able to distinguish benign from malignant lymphadenopathy in patients with thyroid cancer. METHODS: We evaluated lymph nodes in a group of patients with thyroid cancer. Nodes were detected and measured by ultrasonography, and their shape, echogenicity, size, and location were noted. Ultrasonographically guided fine-needle aspiration biopsy (FNAB) was performed, and smears were analyzed cytologically. RESULTS: Ultrasonographically guided FNAB was performed in 578 neck nodes in a group of 631 patients with thyroid cancer. In most cases, metastases had a round shape and various echo structures, with a predomination of hypoechoic nodes without a hilum. There were statistical differences in size between metastatic and benign nodes in terms of maximum diameter, minimum diameter, and volume. Among these, minimum diameter and the shape of the nodes seemed to be the most reliable in suggesting malignancy. A round shape with a longitudinal/transverse ratio of less than 2 of hypoechoic nodes indicated the presence of metastases, and we then performed FNAB. The absence of an echogenic hilum and the presence of cystic portions and calcifications were significantly greater in malignancies than in benign lesions (P<.001). In most cases, metastatic nodules were situated in the lower third of the neck. Reactively enlarged nodes occurred more frequently in the upper part of the neck. CONCLUSIONS: Ultrasonography itself cannot distinguish benign from malignant lesions, but an echographic appearance suggests malignancy and helps in the selection of the node to aspirate with ultrasonographically guided FNAB, which is crucial for a final diagnosis.     

Microcalcifications of non-palpable breast lesions detected by ultrasonography: correlation with mammography and histopathology.

OBJECTIVES: Microcalcifications are generally not demonstrated well on ultrasonography. In this study, we attempted to demonstrate the usefulness of high-resolution ultrasonography in the detection of microcalcifications associated with non-palpable breast cancers. DESIGN: Fourteen patients with non-palpable breast lesions in whom microcalcifications were detected or suspected by ultrasonography and one patient in whom microcalcifications were detected on mammography only were included in the study. Mammography and analysis of biopsy specimens were performed in each patient and the findings were correlated with the ultrasonographic findings. Ultrasonography and mammography were performed independently by different physicians at different times. RESULTS: In three patients < or = 30 years of age, who were not at high risk of breast cancer and who had no evidence of cancer on palpation, high-resolution ultrasonography clearly showed microcalcifications but no mass. Two of these patients had ductal carcinoma in situ and one had small invasive carcinoma with extensive comedocarcinoma. Among the other 12 patients with non-palpable breast lesions, ultrasonography detected microcalcifications accurately in six and suggested possible microcalcifications in a further four. Microcalcifications in all of these ten patients were confirmed by mammography thereafter. Four of these ten patients had ductal carcinoma in situ, with or without invasive carcinoma. Of the remaining two patients, one demonstrated false-positive findings and one false-negative findings on ultrasound. On high-resolution ultrasonography, microcalcifications produced the appearance of twinkling stars (bright dots in different planes) in a dark sky (contrasted against ill-defined hypoechoic patches), corresponding on histopathology to groups of expanded ducts with increased cell density with or without necrosis. CONCLUSION: High-resolution ultrasonography may be used for detection of microcalcifications in non-palpable breast lesions. Ultrasonography is helpful in screening for early breast cancers, especially in young patients who are at risk for breast cancer and in whom mammography is not usually carried out.     

以CK20为标志物对乳腺癌微转移检测的研究

目的探讨乳腺癌微转移的标志基因。方法采用逆转录聚合酶链反应（RT-PCR）方法 ,检测了20例乳癌病人正常乳腺组织、癌组织、淋巴结、外周血、10例乳腺纤维瘤,10例非肿瘤病人淋巴结及外周血中细胞角蛋白19（CK19）、角蛋白20（CK20）的表达。结果乳癌组织、正常乳腺组织、转移淋巴结、纤维腺瘤中CK19、CK20均有很高的表达率。CK20在非肿瘤病人淋巴结和外周血中无表达,而CK19有40%表达。结论来源于上皮细胞的良、恶性肿瘤均遗留上皮细胞表达角蛋白的特征;CK20可以作为乳腺癌病人病理检查为非转移淋巴结和外周血中微小转移的标志基因,CK19则不适合。     

超声对乳腺癌腋窝淋巴结的诊断价值

目的 探讨超声在致密型乳腺疾病中的诊断价值.方法 回顾性分析115例致密型乳腺患者和304例非致密型乳腺患者的超声声像图表现,并与其钼靶X线检查结果和病理结果相比较,统计分析超声对致密型乳腺疾病的检出率和诊断准确率.结果 超声对致密型、非致密型乳腺中的病灶检出率分别为96.3%、98.3%,均显著高于钼靶(36.0%、83.7%;P＜0.01).在致密型乳腺患者中,超声对乳腺癌的诊断敏感度显著高于钼靶(83.9%、51.6%;P＜0.01),但超声对乳腺癌的诊断特异度低于钼靶(88.6%、98.1%;P＜0.01),两者对于乳腺癌的诊断准确度均为87.5%.超声和钼靶对于非致密型乳腺的乳腺癌诊断敏感度、特异度、准确度差异均无统计学意义(P＞0.05).结论 乳腺超声显著提高了致密型腺体中病灶的检出率和乳腺癌的诊断敏感度,是致密型乳腺患者重要补充检查手段.     

Evaluation of lymph node perfusion using continuous mode harmonic ultrasonography with a second-generation contrast agent.

OBJECTIVE: To evaluate the contribution of continuous mode contrast-enhanced harmonic ultrasonography (CE-HUS) with a second-generation contrast agent to the characterization of superficial lymphadenopathies with respect to conventional ultrasonographic techniques (B-mode and power Doppler). METHODS: Fifty-six lymph nodes from 45 patients were studied both by conventional techniques and by CE-HUS. The dimensions, intranodal architecture, margins, and location of vessels were evaluated. Subsequently, all the lymph nodes were examined by CE-HUS, and enhancement of echogenicity was evaluated. The diagnoses obtained by means of fine-needle aspiration cytologic examination, surgical biopsy, or both were compared with those obtained by ultrasonography. RESULTS: Of the lymph nodes examined, 30 were benign and 26 were malignant (18 metastases and 8 non-Hodgkin lymphomas). The study using CE-HUS showed intense homogeneous enhancement in 28 of 30 reactive lymph nodes; perfusion defects in 17, of which 15 were neoplastic and 2 were inflammatory; intense but inhomogeneous speckled enhancement in the early arterial phase in 5 cases of lymphoma; and, last, scarce or absent intranodal enhancement in 4 metastases. The specificity, sensitivity, and accuracy of conventional techniques in differentiation between benign and malignant lymph nodes were 76%, 80%, and 78% versus 93%, 92%, and 92.8% for CE-HUS. The increase in correct diagnoses was significant (P = .05) when conventional ultrasonography was tested against CE-HUS. CONCLUSIONS: Superficial lymph nodes can be characterized as being neoplastic or benign with a high degree of diagnostic accuracy on the basis of the perfusion characteristics evaluated by CE-HUS. This technique has been shown to afford a higher degree of accuracy than currently obtainable by any other ultrasonographic technique.